Healthcare Provider Details

I. General information

NPI: 1962064667
Provider Name (Legal Business Name): REBECCA WEBER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 STONY BROOK RD
STONY BROOK NY
11790-2214
US

IV. Provider business mailing address

1413 STONY BROOK RD
STONY BROOK NY
11790-2214
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-0101
  • Fax:
Mailing address:
  • Phone: 631-444-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102836-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: